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Réanimation

, Volume 21, Issue 4, pp 429–439 | Cite as

Les effets délétères de l’épuration extrarénale dans le traitement de l’insuffisance rénale aiguë

  • K. KloucheEmail author
  • M. Serveaux Delous
  • S. Machado
  • L. Amigues
  • O. Jonquet
Mise au Point / Update

Résumé

La nécessité d’une épuration extrarénale (EER) dans la prise en charge d’une insuffisance rénale aiguë est parfois pourvoyeuse d’effets secondaires délétères qui peuvent affecter sensiblement et durablement le pronostic des patients en bénéficiant. Ces effets délétères multiples dépendent d’abord de l’état clinique du patient, ensuite de la modalité d’épuration utilisée. Dans cette revue, les principales complications liées à l’EER sont décrites en soulignant les stratégies d’épuration et les mesures thérapeutiques permettant de les prévenir ou d’en diminuer l’impact.

Mots clés

Insuffisance rénale aiguë Épuration extrarénale Complications Hypotension intradialytique 

Deleterious effects of renal replacement therapy in the treatment of acute renal failure

Abstract

The need of renal replacement therapy for the treatment of acute renal failure may cause life-threatening complications worsening the short and long term prognosis of critically ill. This review summarizes the common complications associated with renal replacement therapy and assesses the potential therapeutic interventions and dialysis strategies to avoid or minimize this risk in order to improve patient’s health.

Keywords

Acute kidney injury Acute renal failure Renal replacement therapy Complications Intradialytic hypotension 

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Références

  1. 1.
    Uchino S, Kellum JA, Bellomo R, et al (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818PubMedCrossRefGoogle Scholar
  2. 2.
    Nash K, Hafeez A, Hou S (2002) Hospital-acquired renal insufficiency. Am J Kidney Dis 39:930–936PubMedCrossRefGoogle Scholar
  3. 3.
    Metnitz PG, Krenn CG, Steltzer H, et al (2002) Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 30:2051–2058PubMedCrossRefGoogle Scholar
  4. 4.
    Bagshaw SM, George C, Bellomo R (2007) Changes in the incidence and outcome for early acute kidney injury in a cohort of Australian intensive care units. Crit Care 11:R68PubMedCrossRefGoogle Scholar
  5. 5.
    Coca SG, Yusuf B, Shlipak MG, et al (2009) Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 53: 961–973PubMedCrossRefGoogle Scholar
  6. 6.
    Lafrance JP, Miller DR (2010) Acute kidney injury associates with increased long-term mortality. J Am Soc Nephrol 21:345–352PubMedCrossRefGoogle Scholar
  7. 7.
    Wald R, Quinn RR, Luo J, et al (2009) Chronic dialysis and death among survivors of acute kidney injury requiring dialysis. JAMA 302:1179–1185PubMedCrossRefGoogle Scholar
  8. 8.
    Liano F, Junco E, Pascual J, et al (1998) The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group. Kidney Int Suppl 66:S16–S24PubMedGoogle Scholar
  9. 9.
    Elseviers MM, Lins RL, Van Der Niepen P, et al (2010) Renal replacement therapy is an independent risk factor for mortality in critically ill patients with acute kidney injury. Crit Care 14: R221PubMedCrossRefGoogle Scholar
  10. 10.
    Klouche K, Béraud JJ (1998) Risks and hazards of intermittent renal replacement therapy. Claudio Ronco and Rinaldo Bellomo (eds), Critical care Nephrology: 1441–1456, Kluwer Academic PublishersGoogle Scholar
  11. 11.
    Finkel KW, Podoll AS (2009) Complications of continuous renal replacement therapy. Semin Dial 22:155–159PubMedCrossRefGoogle Scholar
  12. 12.
    Schetz M (2007) Vascular access for HD and CRRT. Contrib Nephrol 156:275–286PubMedCrossRefGoogle Scholar
  13. 13.
    Prabhu MV, Juneja D, Gopal PB, et al (2010) Ultrasound-guided femoral dialysis access placement: a single-center randomized trial. Clin J Am Soc Nephrol 5:235–239PubMedCrossRefGoogle Scholar
  14. 14.
    Parienti JJ, Mégarbane B, Fischer MO, et al (2010) Catheter dysfunction and dialysis performance according to vascular access among 736 critically ill adults requiring renal replacement therapy: a randomized controlled study. Crit Care Med 38:1118–1125PubMedCrossRefGoogle Scholar
  15. 15.
    Dugué AE, Levesque SP, Fischer MO, et al (2012) Vascular access sites for acute renal replacement in intensive care units. Clin J Am Soc Nephrol 7:70–77PubMedCrossRefGoogle Scholar
  16. 16.
    Klouche K, Amigues L, Deleuze S, et al (2007) Complications, effects on dialysis dose, and survival of tunneled femoral dialysis catheters in acute renal failure. Am J Kidney Dis 49:99–108PubMedCrossRefGoogle Scholar
  17. 17.
    Parienti JJ, Thirion M, Mégarbane B, et al (2008) Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA 299:2413–2422PubMedCrossRefGoogle Scholar
  18. 18.
    Souweine B, Liotier J, Heng AE, et al (2006) Catheter colonization in acute renal failure patients: comparison of central venous and dialysis catheters. Am J Kidney Dis 47:879–887PubMedCrossRefGoogle Scholar
  19. 19.
    Parienti JJ, Dugué AE, Daurel C, et al (2010) Continuous renal replacement therapy may increase the risk of catheter infection. Clin J Am Soc Nephrol 5:1489–1496PubMedCrossRefGoogle Scholar
  20. 20.
    Gowardman JR, Robertson IK, Parkes S, et al (2008) Influence of insertion site on central venous catheter colonization and bloodstream infection rates. Intensive Care Med 34:1038–1045PubMedCrossRefGoogle Scholar
  21. 21.
    Jaffer Y, Selby NM, Taal MW, et al (2008) A meta-analysis of hemodialysis catheter locking solutions in the prevention of catheter-related infection. Am J Kidney Dis 51:233–241PubMedCrossRefGoogle Scholar
  22. 22.
    Laupland KB, Zahar JR, Adrie C, et al (2012) Severe hypothermia increases the risk for intensive care-unit acquired infection. Clin Infect Dis [Epub ahead of print]Google Scholar
  23. 23.
    Laupland KB, Zahar JR, Adrie C, et al (2012) Determinants of temperature abnormalities and influence on outcome of critical illness. Crit Care Med 40:145–151PubMedCrossRefGoogle Scholar
  24. 24.
    Schortgen F, Soubrier N, Delclaux C, et al (2000) Hemodynamic tolerance of intermittent hemodialysis in critically ill patients: usefulness of practice guidelines. Am J Respir Crit Care Med 162:197–202PubMedGoogle Scholar
  25. 25.
    Tolwani AJ, Wille KM (2009) Anticoagulation for continuous renal replacement therapy. Semin Dial 22:141–145PubMedCrossRefGoogle Scholar
  26. 26.
    Davenport A (2009) Antibodies to heparin-platelet factor 4 complex: pathogenesis, epidemiology, and management of heparininduced thrombocytopenia in hemodialysis. Am J Kidney Dis 54:361–374PubMedCrossRefGoogle Scholar
  27. 27.
    Lim W, Cook DJ, Crowther MA (2004) Safety and efficacy of low molecular weight heparins for hemodialysis in patients with end-stage renal failure: a meta-analysis of randomized trials. J Am Soc Nephrol 15:3192–3206PubMedCrossRefGoogle Scholar
  28. 28.
    Joannidis M, Kountchev J, Rauchenzauner M, et al (2007) Enoxaparin vs. unfractionated heparin for anticoagulation during continuous veno-venous hemofiltration: a randomized controlled crossover study. Intensive Care Med 33:1571–1579PubMedCrossRefGoogle Scholar
  29. 29.
    van der Voort PH, Gerritsen RT, Kuiper MA, et al (2005) Filter run time in CVVH: pre-versus post-dilution and nadroparin versus regional heparin-protamine anticoagulation. Blood Purif 23: 175–180PubMedCrossRefGoogle Scholar
  30. 30.
    Hetzel GR, Schmitz M, Wissing H, et al (2011) Regional citrate versus systemic heparin for anticoagulation in critically ill patients on continuous venovenous haemofiltration: a prospective randomized multicentre trial. Nephrol Dial Transplant 26:232–239PubMedCrossRefGoogle Scholar
  31. 31.
    Oudemans-van Straaten HM, Bosman RJ, Koopmans M, et al (2009) Citrate anticoagulation for continuous venovenous hemofiltration. Crit Care Med 37:545–552PubMedCrossRefGoogle Scholar
  32. 32.
    Monchi M, Berghmans D, Ledoux D, et al (2004) Citrate vs. heparin for anticoagulation in continuous venovenous hemofiltration: a prospective randomized study. Intensive Care Med 30:260–265PubMedCrossRefGoogle Scholar
  33. 33.
    Bakker AJ, Boerma EC, Keidel H, et al (2006) Detection of citrate overdose in critically ill patients on citrate-anticoagulated venovenous haemofiltration: use of ionised and total/ionised calcium. Clin Chem Lab Med 44:962–966PubMedCrossRefGoogle Scholar
  34. 34.
    K/DOQI Workgroup (2005) K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 45:S1–153Google Scholar
  35. 35.
    Palevsky PM, Zhang JH, O’Connor TZ, et al (2008) Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med 359:7–20PubMedCrossRefGoogle Scholar
  36. 36.
    Daugirdas JT (2001) Pathophysiology of dialysis hypotension: an update. Am J Kidney Dis 38:S11–S17PubMedCrossRefGoogle Scholar
  37. 37.
    Vinsonneau C, Camus C, Combes A, et al (2006) Continuous venovenous haemodiafiltration versus intermittent haemodialysis for acute renal failure in patients with multiple-organ dysfunction syndrome: a multicentre randomised trial. Lancet 368:379–385PubMedCrossRefGoogle Scholar
  38. 38.
    Lins RL, Elseviers MM, Van der Niepen P, et al (2009) Intermittent versus continuous renal replacement therapy for acute kidney injury patients admitted to the intensive care unit: results of a randomized clinical trial. Nephrol Dial Transplant 24:512–518PubMedCrossRefGoogle Scholar
  39. 39.
    Schiffl H, Lang SM, Fischer R (2002) Daily hemodialysis and the outcome of acute renal failure. N Engl J Med 346:305–310PubMedCrossRefGoogle Scholar
  40. 40.
    Kumar VA, Craig M, Depner TA, Yeun JY (2000) Extended daily dialysis: A new approach to renal replacement for acute renal failure in the intensive care unit. Am J Kidney Dis 36:294–300PubMedCrossRefGoogle Scholar
  41. 41.
    Marshall MR, Golper TA, Shaver MJ, et al (2001) Sustained lowefficiency dialysis for critically ill patients requiring renal replacement therapy. Kidney Int 60:777–785PubMedCrossRefGoogle Scholar
  42. 42.
    Van der Sande FM, Cheriex EC, van Kuijk WH, Leunissen KM (1998) Effect of dialysate calcium concentrations on intradialytic blood pressure course in cardiac-compromised patients. Am J Kidney Dis 32:125–131PubMedCrossRefGoogle Scholar
  43. 43.
    Selby NM, McIntyre CW (2006) A systematic review of the clinical effects of reducing dialysate fluid temperature. Nephrol Dial Transplant 21:1883–1898PubMedCrossRefGoogle Scholar
  44. 44.
    Cordtz J, Olde B, Solem K, Ladefoged SD (2008) Central venous oxygen saturation and thoracic admittance during dialysis: new approaches to hemodynamic monitoring. Hemodial Int 12:369–377PubMedCrossRefGoogle Scholar
  45. 45.
    Donauer J, Kölblin D, Bek M, et al (2000) Ultrafiltration profiling and measurement of relative blood volume as strategies to reduce hemodialysis-related side effects. Am J Kidney Dis 36:115–123PubMedCrossRefGoogle Scholar
  46. 46.
    Du Cheyron D, Lucidarme O, Terzi N, Charbonneau P (2010) Blood volume- and blood temperature-controlled hemodialysis in critically ill patients: a 6-month, case-matched, open-label study. Blood Purif 29:245–251PubMedCrossRefGoogle Scholar
  47. 47.
    De Backer WA, Verpooten GA, Borgonjon DJ, et al (1983) Hypoxemia during hemodialysis: effects of different membranes and dialysate compositions. Kidney Int 23:738–743PubMedCrossRefGoogle Scholar
  48. 48.
    Rocktaschel J, Morimatsu H, Uchino S, et al (2003) Impact of continuous veno-venous hemofiltration on acid-base balance. Int J Artif Organs 26:19–25PubMedGoogle Scholar
  49. 49.
    Burton JO, Jefferies HJ, Selby NM, McIntyre CW (2009) Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function. Clin J Am Soc Nephrol 4:1925–1931PubMedCrossRefGoogle Scholar
  50. 50.
    Bellomo R, Cass A, Cole L, et al (2009) Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med 361:1627–1638PubMedCrossRefGoogle Scholar
  51. 51.
    Demirjian S, Teo BW, Guzman JA, et al (2011) Hypophosphatemia during continuous hemodialysis is associated with prolonged respiratory failure in patients with acute kidney injury. Nephrol Dial Transplant 26:3508–3514PubMedCrossRefGoogle Scholar
  52. 52.
    Broman M, Carlsson O, Friberg H, et al (2011) Phosphate-containing dialysis solution prevents hypophosphatemia during continuous renal replacement therapy. Acta Anaesthesiol Scand 55:39–45PubMedCrossRefGoogle Scholar
  53. 53.
    Pea F, Viale P, Pavan F, Furlanut M (2007) Pharmacokinetic considerations for antimicrobial therapy in patients receiving renal replacement therapy. Clin Pharmacokinet 46:997–1038PubMedCrossRefGoogle Scholar
  54. 54.
    Eyler RF, Mueller BA (2011) Antibiotic dosing in critically ill patients with acute kidney injury. Nat Rev Nephrol 7:226–235PubMedCrossRefGoogle Scholar
  55. 55.
    Hakim RM, Wingard RL, Parker RA (1994) Effect of the dialysis membrane in the treatment of patients with acute renal failure. N Engl J Med 331:1338–1342PubMedCrossRefGoogle Scholar
  56. 56.
    Alonso A, Lau J, Jaber BL (2008) Biocompatible hemodialysis membranes for acute renal failure.Cochrane Database Syst Rev (1):CD005283Google Scholar
  57. 57.
    Ebo DG, Bosmans JL, Couttenye MM, Stevens WJ (2006) Haemodialysis-associated anaphylactic and anaphylactoid reactions. Allergy 61:211–220PubMedCrossRefGoogle Scholar
  58. 58.
    Davenport A (2009) Continuous renal replacement therapies in patients with liver disease. Semin Dial 22:169–172PubMedCrossRefGoogle Scholar
  59. 59.
    Morath C, Miftari N, Dikow R, et al (2008) Sodium citrate anticoagulation during sustained low efficiency dialysis (SLED) in patients with acute renal failure and severely impaired liver function. Nephrol Dial Transplant 23:421–422PubMedCrossRefGoogle Scholar
  60. 60.
    Davenport A (2001) Renal replacement therapy in the patient with acute brain injury. Am J Kidney Dis 37:457–466PubMedCrossRefGoogle Scholar
  61. 61.
    Klouche K, Béraud JJ (1998) Nutritional requirements in critically ill patients treated with intermittent renal replacement therapy. Claudio Ronco and Rinaldo Bellomo (eds), Critical care Nephrology: 1473–1489, Kluwer Academic PublishersGoogle Scholar
  62. 62.
    Btaiche IF, Mohammad RA, Alaniz C, Mueller BA (2008) Amino Acid requirements in critically ill patients with acute kidney injury treated with continuous renal replacement therapy. Pharmacotherapy 28:600–613PubMedCrossRefGoogle Scholar
  63. 63.
    Gil HW, Yang JO, Lee EY, et al (2007) The effect of dialysis membrane flux on amino acid loss in hemodialysis patients. J Korean Med Sci 22:598–603PubMedCrossRefGoogle Scholar
  64. 64.
    Ronco C, Bellomo R, Homel P, et al (2000) Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet 356:26–30PubMedCrossRefGoogle Scholar
  65. 65.
    Schiffl H, Fischer R (2008) Five-year outcomes of severe acute kidney injury requiring renal replacement therapy. Nephrol Dial Transplant 23:2235–2241PubMedCrossRefGoogle Scholar
  66. 66.
    Ishani A, Xue JL, Himmelfarb J, et al (2009) Acute kidney injury increases risk of ESRD among elderly. J Am Soc Nephrol 20:223–228PubMedCrossRefGoogle Scholar
  67. 67.
    Solez K, Morel-Maroger L, Sraer JD (1979) The morphology of “acute tubular necrosis in man: analysis of 57 renal biopsies and a comparison with the glycerol model. Medicine 58:362–376PubMedCrossRefGoogle Scholar
  68. 68.
    Jacka MJ, Ivancinova X, Gibney RT (2005) Continuous renal replacement therapy improves renal recovery from acute renal failure. Can J Anaesth 52:327–332PubMedCrossRefGoogle Scholar
  69. 69.
    Augustine JJ, Sandy D, Seifert TH, Paganini EP (2004) A randomized controlled trial comparing intermittent with continuous dialysis in patients with ARF. Am J Kidney Dis 44:1000–1007PubMedCrossRefGoogle Scholar

Copyright information

© Société de réanimation de langue française (SRLF) and Springer-Verlag France 2012

Authors and Affiliations

  • K. Klouche
    • 1
    Email author
  • M. Serveaux Delous
    • 1
  • S. Machado
    • 1
  • L. Amigues
    • 1
  • O. Jonquet
    • 1
  1. 1.Service de réanimation médicaleCHU LapeyronieMontpellierFrance

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